What Is the Current Role of an Over-the-Scope Clip Used as First-Line Endoscopic Hemostasis in Patients With Nonvariceal Upper Gastrointestinal Bleeding?
Authors: Alan N. Barkun, Ali A. Alali
Journal: Annals of Internal Medicine (2023)

EditorialsApril 2023What Is the Current Role of an Over-the-Scope Clip Used as First-Line Endoscopic Hemostasis in Patients With Nonvariceal Upper Gastrointestinal Bleeding?Alan N. Barkun, MD, MSc and Ali A. Alali, MBBCh, BAO, MScAlan N. Barkun, MD, MScDivision of Gastroenterology, McGill University and the McGill University Health Centre, Montreal, Quebec, Canada and Ali A. Alali, MBBCh, BAO, MScDepartment of Medicine, Faculty of Medicine, Kuwait University, Jabriyah, KuwaitAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-0449 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The management of patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) has seen substantial evolution with the emergence of novel endoscopic methods—most recently the use of cap-mounted or over-the-scope clips (OTSCs) (1).In their article, Lau and colleagues (2) completed an important trial in patients with NVUGIB, this time assessing OTSCs. Over the past 5 years, 4 randomized controlled trials (RCTs) have compared OTSCs with standard endoscopic hemostasis in NVUGIB, all with some methodological limitations. A small RCT of 66 patients suggested the superiority of OTSCs in patients with recurrent NVUGIB in whom initial standard endoscopic approaches failed (3). Subsequent RCTs ...References1. Bapaye J, Chandan S, Naing LY, et al. Safety and efficacy of over-the-scope clips versus standard therapy for high-risk nonvariceal upper GI bleeding: systematic review and meta-analysis. Gastrointest Endosc. 2022;96:712-20.e7. [PMID: 35803307] doi:10.1016/j.gie.2022.06.032 CrossrefMedlineGoogle Scholar2. Lau JYW, Li R, Tan C, et al. Comparison of over-the-scope clips to standard endoscopic treatment as the initial treatment in patients with bleeding from a nonvariceal upper gastrointestinal cause. A randomized controlled trial. Ann Intern Med. 2023;176:455-62. doi:10.7326/M22-1783 LinkGoogle Scholar3. Schmidt A, Gölder S, Goetz M, et al. Over-the-scope clips are more effective than standard endoscopic therapy for patients with recurrent bleeding of peptic ulcers. Gastroenterology. 2018;155:674-86.e6. [PMID: 29803838] doi:10.1053/j.gastro.2018.05.037 CrossrefMedlineGoogle Scholar4. Jensen DM, Kovacs T, Ghassemi KA, et al. Randomized controlled trial of over-the-scope clip as initial treatment of severe nonvariceal upper gastrointestinal bleeding. Clin Gastroenterol Hepatol. 2021;19:2315-23.e2. [PMID: 32828873] doi:10.1016/j.cgh.2020.08.046 CrossrefMedlineGoogle Scholar5. Laine L, Barkun AN, Saltzman JR, et al. ACG clinical guideline: upper gastrointestinal and ulcer bleeding. Am J Gastroenterol. 2021;116:899-917. [PMID: 33929377] doi:10.14309/ajg.0000000000001245 CrossrefMedlineGoogle Scholar6. Gralnek IM, Stanley AJ, Morris AJ, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) guideline - update 2021. Endoscopy. 2021;53:300-32. [PMID: 33567467] doi:10.1055/a-1369-5274 CrossrefMedlineGoogle Scholar7. Meier B, Wannhoff A, Denzer U, et al. Over-the-scope-clips versus standard treatment in high-risk patients with acute non-variceal upper gastrointestinal bleeding: a randomised controlled trial (STING-2). Gut. 2022;71:1251-8. [PMID: 35321938] doi:10.1136/gutjnl-2021-325300 CrossrefMedlineGoogle Scholar8. García-Iglesias P, Villoria A, Suarez D, et al. Meta-analysis: predictors of rebleeding after endoscopic treatment for bleeding peptic ulcer. Aliment Pharmacol Ther. 2011;34:888-900. [PMID: 21899582] doi:10.1111/j.1365-2036.2011.04830.x CrossrefMedlineGoogle Scholar9. Chan S, Pittayanon R, Wang HP, et al. Use of over-the-scope clip (OTSC) versus standard therapy for the prevention of rebleeding in large peptic ulcers (size ≥1.5 cm): an open-labelled, multicentre international randomised controlled trial. Gut. 2022. [PMID: 36307177] doi:10.1136/gutjnl-2022-327007 CrossrefMedlineGoogle Scholar10. Hollenbach M, Decker A, Schmidt A, et al. A comparison between traumatic and atraumatic over-the-scope-clips in patients with duodenal ulcer bleeding: a retrospective analysis with propensity-score-based matching. Gastrointest Endosc. 2023. [PMID: 36738794] doi:10.1016/j.gie.2023.01.051 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Alan N. Barkun, MD, MSc; Ali A. Alali, MBBCh, BAO, MScAffiliations: Division of Gastroenterology, McGill University and the McGill University Health Centre, Montreal, Quebec, CanadaDepartment of Medicine, Faculty of Medicine, Kuwait University, Jabriyah, KuwaitDisclosures: Authors have reported no disclosures of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-0449.Corresponding Author: Alan N. Barkun, MD, MSc, Division of Gastroenterology, McGill University Health Centre, Room D7-346, 1650 Cedar Avenue, Montreal, QC H3G 1A4, Canada; e-mail, Alan.Barkun.[email protected]gouv.qc.ca.This article was published at Annals.org on 7 March 2023. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoComparison of Over-the-Scope Clips to Standard Endoscopic Treatment as the Initial Treatment in Patients With Bleeding From a Nonvariceal Upper Gastrointestinal Cause James Y.W. Lau , Rui Li , Chen-huan Tan , Xiu-jing Sun , Hao-jun Song , Lan Li , Feng Ji , Bu-jiang Wang , Dong-tao Shi , Wai K. Leung , Imogen Hartley , Alan Moss , Karina Y.Y. Yu , Bing Y. Suen , Peng Li , and Francis K.L. Chan Metrics Current IssueApril 2023Volume 176, Issue 4Page: 576-577KeywordsClinical trialsEsophagogastroduodenoscopyHemostatics ePublished: 7 March 2023 Issue Published: April 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. 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